@Jen Thanks for the nice words. I should dig up my records from when I started the CGM last September to compare with the MDI one. That would show a much bigger improvement.

To bring up an old topic, I just got my A1C back and sadly did not break into the 5’s. My typical A1C has always been about 0.5% higher than I would expect based on my 90-day meter or CGM averages. My last 90 day average is 6.5 mmol/l (117 mg/dl) but the A1C is 6.1% versus the 5.7% that I would expect with the magic formula. The good news is that my 30 day average is 5.9 mmol/l (106 mg/dl) so if I can keep that up, even with my 0.5% A1C problem, I may see a five…

Terry4:

Extended boluses are great for high fat meals, too. It’s a great technique, very effective and relatively easy to calibrate.

I am mentally not there to start counting the fat content of food. This is probably me rebelling against the old exchange diet of old where I was obsessively counting all the macronutirents. I look at improving diabetes control like swimming in a cold lake - Once you get your whole body under the water it is nice and refreshing, but there is always that irrational hesitation to get more of your body wet because your brain is thinking about how cold it is going to be. I am slowly going into the lake and probably up to my waist right now. I am not one to just jump into the lake like some people I know

Ok @Terry4 - so the hold up with the fat is really me being too lazy to put the effort in to counting fat in the first place and then figuring out how long to do the extend bolus. With protein - I bolus for 50% of the protein grams and then extend the bolus so that I deliver no more than about 1.3 to 1.5 U/hr. Before you were looping, how did you handle the fat? Any good “fat counting” resources out there?

Before you were looping, how did you handle the fat? Any good “fat counting” resources out there?

I counted 50% of the protein grams and 10% of the fat grams, added them together and divided by my insulin to carb ratio. That would give me the total extended bolus amount. I would then deliver that extended (square) bolus at an hourly rate no greater than 1.2 units per hour. If I needed to deliver 4.8 units then I would do 1.2 unit/hour for four hours.

When I first started doing this I would use my food scale and Calorie King. But I don’t eat a large variety of meals so I was able to memorize the doses for the meals I favored.

By the way, an extended bolus miscalculation was much easier to counteract than a carb bolus miscalculation since it slowly took effect over time.

I like your lake analogy @AE13:) My lab A1c is usually 0.4 higher than my 90 day CMG value, too. Since I started Dexcom and OmniPod about 2 years ago, I’ve been under 6% with most recent 4.9. It is still a huge effort as I tend to be very aggressive handling highs and hence too frequently go low.

I have started using the extended bolus recently, too, after hearing how @Terry4 and others use it. It really helps with the lows I experience during meals especially dinner. Everyday seems to be different though despite eating essentially the same thing but I keep trying:)

Seems to be flattening out my spikes a bit. My fasting numbers are better, though I’m still rising a bit during the morning, unrelated to food. My average TDD seems to have dropped a little bit (a little less than 10%) to 36.5U. Don’t see a difference in my appetite, though my reported average carbs are also down somewhat, as well.

I needed a day like this…finally! My blood sugars have been chaotic lately, although my overall averages are still the best they’ve ever been, so I’m looking forward to seeing what my A1c is in about a month.

This line includes two lows I was able to head off with glucose tablets and two meals. I’m still trying to find the magical balance that will make control, while maybe not “easy”, at least not a struggle every day. Every time I think I’ve found it, the balance lasts about a week before things turn chaotic again and I have to readjust all my ratios and basal rates.

In six weeks I’ll be starting a three-month internship in a profession that is not only very variable from day to day but I also need to be focused at all times so I can keep students/clients safe, and so I’m really motivated to find something that will allow my blood sugars to cruise throughout the day without having to spend all day looking at my CGM and munching on glucose tablets and doing micro-boluses. Yesterday was a weekend sitting around doing nothing, but on days I’m out and walking around all day, the flatline is so much harder to achieve.

Great line, @Jen. I know how hard you work, you should feel pride when things work well.[quote=“Jen, post:1056, topic:22716”]
Every time I think I’ve found it, the balance lasts about a week before things turn chaotic again and I have to readjust all my ratios and basal rates.
[/quote]

Your experience, especially, reminds us that blood glucose management is a moving target. Easy to control diabetes is not “normal,” although some people are luckier than others that way. Thank you for sharing your experience.

Good luck with your internship. It sounds challenging from a BG management perspective but good planning and anticipation of your work environment should help you keep things relatively uneventful. Keep on keeping on!

By the way, I continue to use and enjoy the GoTubb 3-pack glucose tab containers you wrote about here recently.

We shall see as to the value of Victoza for me. This weekend, its impact seemed to have been blunted. Today, FBG was still good, but I was forced to take corrections throughout the day to keep in range - without having eaten any significant amount of carbs. In addition, those spikes I usually get on Friday and Saturday came back closer to my ‘normal’ (pre-Victoza) spikes, indicating less impact from the medication.
Side effects seem to be hanging in, though, I haven’t hit the “magic” 2-week mark yet, where I’m told they tend to subside – we’ll see. These include dizziness/light-headedness and pounding heartbeat. I’ve also noticed that I’ve been craving sugar lately (which I have not had a problem with in quite some time) and that I have been drinking a LOT more water and other liquids than I had been – and I had been drinking a lot. These last two issues concern me, as I don’t understand why.

I examined my pump data over the last 11 days (since stating Victoza) – my average TDD has in fact dropped somewhat from 42.5U to 39.5U, even though my average total carbs remains rather constant at 46G. I have seen no indication of weight loss, however – and that was the primary goal of my endo in asking me to try this med. I suppose, it’s early yet, so we will see…

Your experience, especially, reminds us that blood glucose management is a moving target. Easy to control diabetes is not “normal,” although some people are luckier than others that way. Thank you for sharing your experience.

“Easy” is perhaps the wrong word, since diabetes is never easy. I guess consistency is what I meant. It would be nice if I could land on a set of ratios and basal rates that would last for six months with just minor “sugar surfing” tweaks throughout the day. It boggles my mind how yesterday was so great, this morning was great, yet since noon I’ve hit 2.6 mmol/L (46 mg/dl) and 14.1 mmol/L (253 mg/dl) and have been out of range for most of the past eight hours. For me, it just seems like my diabetes is exquisitely sensitive and extremely easy to knock out of range while at times being very difficult to get (and stay) back in range. Oh well, I’m not sure I’ve managed an entire day completely in range in months, so I suppose it’s still a victory, even if I can’t stop to celebrate.

Finally!! After days of running high, I finally spent a good 24 hours in range. It only took raising my basal rate by 18 units and dropping my carb and correction ratios by a third! Now I need to be looking out for the drop when all of this returns to baseline overnight.

The last two weeks of my data has an average blood sugar of 6.2 mmol/L (111 mg/dl), a standard deviation of 2.1 mmol/L (37 mg/dl), and 72% of readings between 4.0 and 8.0 (70-140ish). This is better control than I’ve ever had between Fiasp, low-carb, and setting my Dexcom limits slightly more narrow than my target. I get my A1c done today, so I’m looking forward to seeing the results!

The one downside of my control being so much better is that I feel terrible when my blood sugar is running high, to the point it’s hard to function sometimes because I get so tired once my blood sugar goes above about 10 mmol/L (180 mg/dl) for any length of time. This wouldn’t be such a bad thing if every high were caused by eating high-carb food, because that would be good motivation to stay away from such things. But it gets annoying when I run high for days on end due to something completely out of my control!

That’s a nice 24 hours, @Jen! I think your willingness to make changes really helps. I hope this new combination of Fiasp, low-carb eating, and narrowing your Dexcom limits continues to work for you. Keep up the great work!

I hope this new combination of Fiasp, low-carb eating, and narrowing your Dexcom limits continues to work for you.

And of course I forgot sugar surfing! It seems I need to use a combination of all these strategies to keep good control, and yes, being willing to make huge changes such as a 50% increase in my basal rates over 48 hours is a big part of it for me (I wish I could do it over 12 hours so I wouldn’t spend those few days high, I still need to look into that temperature thing someone mentioned as a way of tracking hormones…it’s just another thing that I keep putting off!). During that graph yesterday there were two points where I ate glucose tablets to head off lows. Another point at dinner I bolused for chicken protein over five hours, then started to drop so set my basal rate to 0% for half an hour (which I find usually bumps me up by about 1.5 mmol/L) and eventually cancelled the extended bolus and ate two glucose tablets. So that didn’t work so well, but I did have a shadow of my overnight rise that I suspect is from protein. I’m thinking maybe I need to start the extended bolus an hour or two after the meal instead of right at the meal, and maybe extend it out over a longer period.

After a crazy heatwave in the past week that got my BG all over the place, yesterday wasn’t too shabby.
I’m just annoyed I had to have my 2 hour sensor warmup—hence the gap but I finger pricked and was going steady in the 90s.

The one downside of my control being so much better is that I feel terrible when my blood sugar is running high, to the point it’s hard to function sometimes because I get so tired once my blood sugar goes above about 10 mmol/L (180 mg/dl) for any length of time.

I agree completely - it is like you can’t function. I was over 10 (180) last Wednesday after a pod started leaking around the cannula (too much sweating during the heat and I hadn’t noticed the adhesive getting loose as it was on my back). Boy was I in a foul mood.

I am currently in a state of diabetes zen for me (not as good as @MayaK though ) A couple of days ago I went against my normal practice of only adjusting one thing at a time and completely re-did my basal rates based on my 7 day trend. The new basal rates are performing very well.

The nice thing about having the basal rates in a good place (which does not often happen for me) is you can explain all the little changes in the blood glucose. For example, yesterday at dinner around 5pm, I got the carb count wrong on something and I got a rise out of dinner (ok - I ignored the carbs in the berry sauce and sugary chocolaty bits I put on top of the ice cream . I then hit it with a unit of Fiasp just before 8pm and it dropped back to where it should be very quickly.

There must be something in the air with this flurry of flatlines breaking out around the D-world. Way to go, @MayaK and @AE13! I think the people who appreciate the beauty of a flatline are those of us who strive for that every day and realize how much work and attention goes into it.

Anyone else follow the new AGP (ambulatory glucose profile) report in Clarity? I find the 14-day version helpful in identifying what I need to work on next. I eat two meals per day and this AGP report clearly shows that I eat my first meal at midday and my next one in the early evening. I need to sort out my prandial insulin dosing so that I can pull at least the 75th percentile line down to below my upper target of 120 mg/dL (6.7 mmol/L). My target range (the upper and lower black lines on the graph is 65-120 mg/dL (3.6-6.7 mmol/L)